Technetium-99m-labeled Macroaggregated Albumin Lung Perfusion Scan for Diagnosis of Hepatopulmonary Syndrome: A Prospective Study Comparing Brain Uptake and Whole-body Uptake

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2020 Mar 25

PMID 32205999

Citations 4

Authors

He Zhao

Jiaywei Tsauo

Xiao-Wu Zhang

Huai-Yuan Ma

Ning-Na Weng

Gong-Shun Tang

Xiao Li

Affiliations

Soon will be listed here.

Abstract

Background: Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension. This syndrome occurs most often in cirrhotic patients (4%-32%) and has been shown to be detrimental to functional status, quality of life, and survival. The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (., diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects, preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient, respectively.

Aim: To compare brain and whole-body uptake of technetium for diagnosing HPS.

Methods: Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included. Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs, respectively.

Results: Thirty-two (46%) patients had IPVD as detected by contrast-enhanced echocardiography. The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71 ± 0.18 mg/dL 0.83 ± 0.23 mg/dL; = 0.041), alveolar-arterial oxygen gradient (23.2 ± 13.3 mmHg 16.4 ± 14.1 mmHg; = 0.043), and arterial partial pressure of oxygen (81.0 ± 12.1 mmHg 90.1 ± 12.8 mmHg; = 0.004). Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0% ± 6.1% 40.1% ± 8.1%; = 0.001). The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 0.54; = 0.025). The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7% and 42.5%, respectively, based on Youden's index. The sensitivity, specificity, and accuracy of brain uptake > 5.7% and whole-body uptake > 42.5% for detecting IPVD were 23%, 89%, and 59% and 100%, 52%, and 74%, respectively.

Conclusion: Whole-body uptake is superior to brain uptake for diagnosing HPS.

Citing Articles

Diagnostic Potential of 99mTc-macroaggregated Albumin Scintigraphy in the Diagnosis of Hepatopulmonary Syndrome: Insights from Two Case Studies and Critical Review of Literature.

Singh P, Singhal T, Palanivel P, Dhar P, Narayan M Indian J Nucl Med. 2025; 39(4):304-308.

PMID: 39790825 PMC: 11708794. DOI: 10.4103/ijnm.ijnm_18_23.

Imaging in hepatopulmonary syndrome-case report. A multicenter approach during the coronavirus pandemic.

Ahmmed A, Kulshrestha R J Radiol Case Rep. 2024; 17(10):1-13.

PMID: 38343884 PMC: 10852050. DOI: 10.3941/jrcr.v17i8.4411.

Advances in Diagnostic Imaging of Hepatopulmonary Syndrome.

Luo B, Du Z Front Med (Lausanne). 2022; 8:817758.

PMID: 35083259 PMC: 8784805. DOI: 10.3389/fmed.2021.817758.

Reply to Comment on: Lung Perfusion Imaging with Technetium-99m-macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome.

Assadi M Mol Imaging Radionucl Ther. 2021; 30(1):67-68.

PMID: 33586414 PMC: 7885273. DOI: 10.4274/mirt.galenos.2021.58561.

Lung Perfusion Imaging with Technetium-99m Macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome.

Meristoudis G, Keramida G, Ilias I Mol Imaging Radionucl Ther. 2020; 29(3):143-144.

PMID: 33094580 PMC: 7583746. DOI: 10.4274/mirt.galenos.2020.52244.

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